Shell Shock: The Response of UK Neurology.

The neurological and psychological manifestations of trauma, confinement, and terror became apparent throughout Europe as soldiers were evacuated from the trenches of the Western Front. The response in the UK evolved as a result of the experience of medical staff embedded with the troops in base hospitals and the philosophy of those treating returned soldiers in specialist establishment. There were widely disparate approaches to the management encompassing simple supportive care, a psychanalytic approach and radical electric shock therapy. The latter was partially driven by the Queen Square experience in the UK but was also concurrently widely pursued throughout Europe. With experience, care was increasingly undertaken close to the front lines using a philosophy of immediacy and expectation of recovery. Post-war analysis was startlingly unsympathetic, yet the experiences and management of shell shock have guided psychiatric and medical understanding of functional illness and post-traumatic stress over the subsequent century. In this historical review, we have sought to present features of the UK response to the neurological manifestations of trauma, the way in which these changed as the war proceeded and the political and medical response in the aftermath of war.

"Missing in Action" in Psychiatric Nursing History: The Role of Chief Nurse Adele S. Poston and Her Band of Nurses During World War I.

This is the first nursing journal article to introduce the pioneering work of American psychiatric nurse leader, Adele S. Poston. Poston supervised a team of nurses as they cared for soldiers serving with the American Expeditionary Forces during World War I in France. Poston and her nurses worked in the first American specialized neuropsychiatric hospital in a war. The soldiers they treated primarily had functional nervous disorders described at that time as "shell shock" or "war neuroses." The traumatized officers and enlisted men were considered capable of being cured and returned to active duty based on research done by American psychiatrists among British troops during the first 3 years of the war. The story of Poston's career prior, during, and after the war and her work with other nurses during a global war are significant in psychiatric nursing history. Bringing this hitherto missing piece of psychiatric and nursing history into the light gives us a unique opportunity to recognize Poston and the nurses who served with her, even as today we recognize the nurses who serve during the global COVID-19 pandemic. [Journal of Psychosocial and Mental Health Services, 59(6), 37-47.].

Functional neurology after the Second World War: The beginnings of neurology on screen (III).

Treatment of functional symptoms has a long history, and interventions were often used in soldiers returning from battle. On the 75th anniversary of the end of the Second World War, I review the portrayal of neurology in documentary film. Two documentaries were released in 1946 and 1948 (Let There Be Light and Shades of Gray, respectively), which showed a number of soldiers with functional neurology including paralysis, stuttering, muteness, and amnesia. The films showed successful treatments with hypnosis and sodium amytal by psychoanalytic psychiatrists. These documentaries link neurology with psychiatry and are remarkable examples of functional neurology and its treatment on screen.

Navegación e historia de la ciencia: el hundimiento del Gustloff (Derecho de la Guerra) / Navigation and history of science: the sinking of the Gustloff (The Laws of War)

Al inicio de 1945 el terror se apoderó del Tercer Reich cuando el Ejército Rojo comenzó a invadir los territorios orientales de Prusia, Polonia, Curlandia y Memel. Los mandos de la Marina de Guerra alemana (Kriegsmarine) eran conscientes de que la guerra estaba perdida y de que los civiles serían masacrados por las tropas soviéticas y los nativos eslavos en búsqueda de venganza. De ese modo, decidieron destinar todos sus buques disponibles al Mar Báltico para evacuar a más de 2 millones de soldados, heridos, mujeres, niños, ancianos, colaboracionistas y prisioneros en un heroico episodio que sería conocido con el nombre de Operación Hannibal. El buque KdF Wilhelm Gustloff fue trágico testigo de lo que allí sucedía

At the beginning of 1945, terror invaded the Third Reich when the Red Army began to invade the eastern territories of Prussia, Poland, Courland and Memel. The high command of the German Navy (Kriegsmarine) were aware that the war was lost and that civilians would be slaughtered by Soviet troops and Slavic natives in search of revenge. Thus, they decided to allocate all their available ships to the Baltic Sea to evacuate more than 2 million soldiers, wounded, women, children, elderly, collaborators and prisoners in a heroic episode that would be known as "Operation Hannibal." The ship KdF Wilhelm Gustloff was a tragic witness to what was happening there

Hurst Rehabilitated: the treatment of functional motor disorders by Arthur Hurst during the First World War.

Arthur Hurst was a British First World War physician, best known for his films of shell shock, 'War Neuroses'. He has often been portrayed an innovative pioneer of somewhat mysterious 'suggestion' techniques for functional motor disorders but also as an ambitious clinician who exaggerated the effectiveness of his treatments and failed to address psychological factors. His use of suggestion, persuasion and re-education together with occupational therapy, for chronic or severe cases of shell shock stirred controversy at the time because of the dramatic nature of some of his treatment responses and lack of outcome data. In part, this was a turf war between neurologists and psychiatrists for a dominant therapeutic model. A re-evaluation of his publications and new research into soldiers treated at Seale Hayne in Devon show that Hurst pioneered multidisciplinary and empathetic treatments for functional motor disorders with good short-term outcomes, though insufficient data survives to assess longer term outcomes.

Por una antropología del recuerdo. Historia oral de los cuidados durante la Guerra Civil / For an anthropology of memory. Oral history of care during the Civil War

OBJETIVO: reconstruir las condiciones sociosanitarias experimentadas durante la Guerra Civil a través de la historia oral de sus últimos testigos vivos, los nonagenarios que entonces eran niños. METODOLOGÍA: se empleó un enfoque fenomenológico utilizando como diseño de investigación los testimonios focalizados recogidos a través de entrevistas semiestructuradas realizadas a seis nonagenarios que durante la Guerra Civil presentaban entre seis y diez años. Resultados principales: los informantes hacen una reconstrucción oral del recuerdo centrado en aspectos como las experiencias traumáticas (bombardeos, reclutamientos, ejecuciones), las condiciones sociales (hambre, refugiados, educación), el cuidado, y la vivencia de la infancia. Conclusión principal: los relatos muestran las dramáticas situaciones vividas durante este complicado periodo de la historia de España, experiencias que, sin embargo, no lograron robar totalmente la infancia a aquellos niños que ahora son nonagenarios

OBJECTIVE: the objective of the article has been to reconstruct the social and health conditions experienced during the Civil War through the oral history of its last living witnesses, the nonagenarians who were then children. METHODS: A phenomenological approach was used, using as research design the focused testimonies collected through semi-structured interviews carried out with six nonagenarians who were between six and ten years old during the Civil War. RESULTS: the informants make an oral reconstruction of the memory focused on aspects such as traumatic experiences (bombings, recruits, executions), social conditions (hunger, refugees, education), care, and the experience of childhood. CONCLUSIONS: the stories show the dramatic situations experienced during this complicated period in the history of Spain, experiences that, however, did not completely steal childhood from those children who are now in their early thirties

La Sanidad Militar española durante la primera mitad del siglo XX. Una aproximación histórica. Antecedentes, Guerra Civil - "Método Español" y Proyección Internacional - Autogiro de Juan de la Cierva / Spanish Military Healthcare in the first half of the 20th century. A historic approach. Background, Civil War, "Spanish Method" and International Projection- Juan de la Cierva's Autogyro

La Sanidad Militar es una parte esencial dentro del organigrama de cualquier ejército. Dentro de España, ha sido desarrollada hasta nuestros días, con un impulso forzado durante los conflictos bélicos, especialmente la Guerra Civil (1936-1939). Con unos claros antecedentes, derivados de su propia historia y experiencias, la Sanidad Militar durante la Guerra Civil desarrolló y puso en práctica nuevas técnicas sanitarias como el "Método Español". Junto a lo anterior, una de las mayores innovaciones de orígen español será la invención, en 1920, del autogiro de Juan de la Cierva. Predecesor de los helicópteros, esta aeronave fue puesta al servicio de la Aviación Sanitaria europea y mundial. Todas las innovaciones, militares y sanitarias, surgidas en España durante el conflicto civil, tendrán un reflejo y aplicación en los diferentes países europeos, sobre todo en la II Guerra Mundial. Dicha contribución generalmente ha pasado desapercibida dentro de nuestras fronteras, pero no así en ámbito internacional donde son ampliamente reconocidas personalidades como Juan de la Cierva o el Doctor J. Trueta i Raspall

The military health is an essential part within the organization of any army. In Spain, it has been developed to the present day, with momentum forced during armed conflicts, especially the Civil War (1936-1939). With a clear background, derived from its own history and experiences, the military health during the Civil War developed and implemented new sanitary techniques such as the "Spanish method". Along with the above, one of the major innovations of Spanish origin was the invention, in 1920, of Juan de la Cierva's autogiro. Predecessor of the helicopters, this aircraft was at the service of European health and global aviation. All the innovations, both military and health, arising in Spain during the civil conflict, had a reflection and application in different European countries, especially during World War II. This contribution has generally gone unnoticed within our borders, but not at international level where Juan de la Cierva or Doctor J. Trueta i Raspall are widely-recognized figures

Creative Minds in the Aftermath of the Great War: Four Neurologically Wounded Artists.

Many artists were involved in the First World War. Some of them were mobilized, like millions of soldiers, others enlisted to fight on the battlefield. The stories of writers who returned neurologically wounded from the war, such as Guillaume Apollinaire (1880-1918) or Blaise Cendrars (1887-1961), are well-known. The cases of painters and sculptors who suffered from First World War neurological wounds are scarce. Nevertheless, their injuries led to intense modifications of artistic practice. We detail four examples of artists whose creative mind was impacted by their First World War neurological wounds or diseases. The painter Jean-Julien Lemordant (1878-1968), who suffered from blindness after his injury, stopped his artistic work and became an icon of Franco-American friendship. The sculptor Maurice Prost (1894-1967), suffering from a neuroma due to the loss of his arm, built a special device to continue his work as a wildlife artist. The painter Georges Braque (1882-1963) was trepanned but carried on with his cubist work without ever mentioning the conflict. Conversely, the painter Fernand Léger (1881-1955), who suffered from a war neurosis, produced a significant war testimony through drawings and letters.

Writers as Shell Shock Witnesses during World War I.

The issue of First World War shell shock has been documented mainly from a medical perspective. Many medical texts dealing with war psychoneuroses and their aggressive treatments, such as electrotherapy, were published during the war. Accounts from shell-shocked soldiers are rare. Nevertheless, shell shock was described from a non-medical point of view by a few writers who had undergone or witnessed this pathology. Their texts deal mainly with the psychiatric forms, the most striking ones, but also with the more common concepts of commotion, emotion and pathological fear. The French philosopher Émile Chartier (1868-1951), alias Alain, described the commotional syndrome from which he suffered. The German writer Ernst Jünger (1895-1998), a brave officer and an example for his men, reported his emotional shock. Some psychiatric forms of shell shock are present in the work of the pacifist writer Jean Giono (1895-1970), the naturalist Maurice Genevoix (1890-1980), who suffered himself from a section of the left median and ulnar nerves, or the British poet Siegfried Sassoon (1886-1967). War hysteria and pathological fear have been described, on several occasions, by Blaise Cendrars (1887-1961) or the German writer Erich Maria Remarque (1898-1970). Electrotherapy has been scarcely reported except by Louis-Ferdinand Céline (1894-1961).

Abrupt treatments of hysteria during World War I, 1914-18.

Case reports of the abrupt recovery of hysterical disorders during World War I (1914-18), though undoubtedly subject to publication bias, raise both aetiological and treatment issues regarding pseudo-neurological conversion symptoms. Published clinical anecdotes report circumstantial, psychotherapeutic, hypnotic, persuasive (and coercive) methods seemingly inducing recovery, and also responses to fright and alterations of consciousness. The ethics of modern medical practice would not allow many of these techniques, which were reported to be effective, even in the chronic cases.

Edgar Adrian (1889-1977) and Shell Shock Electrotherapy: A Forgotten History?

The English electrophysiologist Edgar Adrian (1889-1977) was the recipient of the Nobel Prize for physiology in 1932 for his research on the functions of neurons. During World War I, at Queen Square in London, he devised an intensive electrotherapeutic treatment for shell-shocked soldiers. The procedure, developed with Lewis Yealland (1884-1954), was similar to "torpillage," the faradic psychotherapy used in France. Adrian and Yealland considered that the pain accompanying the use of faradic current was necessary for both therapeutic and disciplinary reasons, especially because of the suspicion of malingering. According to Adrian, this controversial electric treatment was only able to remove motor or sensitive symptoms. After the war, he finally admitted that war hysteria was a complex and difficult phenomenon.

The relationship between the First World War and neurology: 100 years of "Shell Shock".

The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an "epidemic" of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or "war neurosis". Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

The relationship between the First World War and neurology: 100 years of "Shell Shock" / A relação entre a Primeira Guerra Mundial e a neurologia: 100 anos do "Shell Shock"

ABSTRACT The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an “epidemic” of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or “war neurosis”. Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

RESUMO A Primeira Guerra Mundial foi uma guerra global, iniciada em 28 de julho de 1914, até 11 de novembro de 1918. Logo após o início da guerra, exatamente há 100 anos, houve uma “epidemia” de sintomas neurológicos conversivos. Soldados de ambos os lados começaram a apresentar com frequência sintomas neurológicos, tais como: tontura, tremor, paraplegia, zumbido, amnésia, fraqueza, cefaleia e mutismo de origem psicossomática. Esta condição ficou conhecida como shell shock, ou “neurose de guerra”. Como muitos sintomas e doenças inexplicadas continuam sendo um grande desafio, e considerando a estreita relação dos sintomas descritos no shell shock com a neurologia clínica, torna-se importante estudar essa parte da história com o objetivo de entendermos e melhorarmos os cuidados aos pacientes.

En los inicios de la psiquiatría franquista. El Congreso Nacional de Neurología y Psiquiatría (Barcelona, 1942) / The beginning of Francoist psychiatry. The National Neurology and Psychiatry Conference (Barcelona, 1942)

Aunque existen algunas aportaciones sobre las características de la psiquiatría franquista, lo cierto es que faltan trabajos que aborden el proceso de reorganización de los profesionales de la medicina mental en el «Nuevo Estado». En este sentido, el Congreso Nacional de Neurología y Psiquiatría, celebrado en Barcelona los días 12, 13 y 14 de enero de 1942, constituye, sin duda, un muy destacado ejemplo de dicho intento de sustitución de ideas y protagonistas en la psiquiatría española. El objeto de este artículo es analizar los principales aspectos organizativos del mencionado Congreso, así como sus contenidos más destacados, con el fin de valorar su importancia estratégica en el marco de los intereses profesionales y científicos, pero también ideológicos y políticos, de los psiquiatras. Las ponencias y comunicaciones versaron sobre neurología y psiquiatría de guerra; avitaminosis y sistema nervioso; y nuevos tratamientos en psiquiatría, en especial las terapias de choque. Asimismo, el congreso tuvo un marcado carácter ideológico y supuso el inicio de una dinámica profesional, con la aparición o el afianzamiento de nuevos líderes que pretendieron sentar las bases de la psiquiatría durante el primer franquismo (AU)

While there has been some research into Francoist psychiatry, much work still needs to be done on the reorganization of the mental health profession within the new state. Held in Barcelona on 12, 13 and 14th January 1942, the National Neurology and Psychiatry Conference undoubtedly played a major role in the attempt to overthrow the dominant ideas in the field of Spanish psychiatry and displace its most influential figures. This article seeks to analyse the Conference's main organizational features and examine its most significant content, with the aim of evaluating its strategic importance in the context of both the psychiatrists' professional and scientific interests and their ideological and political concerns. Conference papers tackled issues such as neurology and psychiatry in wartime, vitamin deficiency and the nervous system, and new psychiatric treatments, including shock therapy. The Conference's marked ideological nature represented the beginning of a new professional dynamic, featuring the emergence or establishment of new leaders intent on laying the foundations of psychiatry during the early years of the Franco regime

Intellectual disabilities in East and West Germany: a brief comparative history / Discapacidades intelectuales en Alemania Oriental y Occidental: una breve historia comparada

The article reconstructs how the different parts of Germany began to rebuild a system of medical care and education for people with disabilities after WW II. Furthermore, the struggle between medicine and education will be addressed. Using the example of intellectual disabilities, the article examines how different ideological backgrounds influenced both, perceptions of disabilities as well as the professional ways in which they were dealt with. By analyzing several contemporary sources, this article will show how professionals thought about disabilities in general and intellectual disabilities in particular. The study will compare the different narratives about intellectual disabilities by analyzing psychological, medical and educational journals as well as reports of contemporary witnesses (AU)

Este artículo reconstruye la manera en la que las diferentes zonas de Alemania surgidas tras la II Guerra Mundial comenzaron a reconstruir un sistema de asistencia médica y de educación destinado a las personas con discapacidades. En él se presta atención además al enfrentamiento existente entre la educación y la medicina. Tomando como ejemplo las discapacidades intelectuales, este trabajo examina la forma en que los diferentes referentes ideológicos influyeron tanto en la manera en la que se percibieron las discapacidades como en el modo en que los profesionales se enfrentaron a ellas. A través del análisis de diversas fuentes de la época, el artículo mostrará la manera en la que los profesionales entendieron las discapacidades en general y de manera especial las discapacidades intelectuales. El estudio comparará diferentes narrativas sobre la discapacidad intelectual analizando revistas psicológicas, médicas y educativas así como informes de testigos de ese momento (AU)

A war psychiatry approach to warfare in the Middle Byzantine period.

Combat stress cases were traced in historical texts and military manuals on warfare from the Middle Byzantine period; they were mainly labelled as cowardice. Soldiers suffered from nostalgia or exhaustion; officers looked stunned, or could not speak during the battle. Cruel punishments were often enforced. Suicide and alcohol abuse were rarely mentioned. The Byzantines' evacuation system for battle casualties was well organized. Psychological operations were conducted and prisoners-of-war were usually part of them. The Byzantine army had 'parakletores', officers assigned to encourage soldiers before combat. The leaders dealt with combat stress by using their rhetoric skills and emphasizing religious faith in eternal life. The treatment of the 'cowards' was rather similar to modern war psychiatry principles of treatment. No description of PTSD was found.